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Nurse Amanda Eubanks, left, works with pharmacist Thy Truong on a patient’s electronic health record through a system called Eclipsys at Our Children’s House at Baylor University Medical Center in Dallas.

North Texas hospital systems are moving quickly to install electronic medical record networks, but the road to full implementation will be long, expensive and full of twists, hospital officials say.

The region’s largest systems have spent or plan to spend hundreds of millions of dollars in their attempts to meet the standards of the health care overhaul and put the power of information to better use for patients. The health care reform law passed in March requires all hospitals to adopt electronic health records and track and report patient outcomes.

Hospitals face loss of some Medicare and Medicaid funding for not complying, beginning in January 2015.

The hospitals’ common goal is to build an infrastructure of computerized medical records to link all health care providers — from the time a patient mentions a medical concern to a primary care physician, through referral to a specialist, possible admission to the hospital, then post-hospital care. Ultimately, this will form a national health-care network.

Texas Health on track

Arlington-based Texas Health Resources, which operates 13 hospitals in the D-FW area, has finished implementing electronic health records in all of its hospitals except Texas Health Presbyterian Hospital Denton, said Dr. Ferdinand Velasco, the system’s chief medical information officer. That hospital joined the system late last year, and will be online by next year, he said.

Texas Health started installing its electronic medical records system four years ago and expects to spend more than $200 million by 2012 in capital and operating expenses to put the system in place, said Edward Marx, chief information officer. The hospital system expects to receive about $70 million in federal stimulus money over five years, beginning in early 2011, Velasco said.

Patients are already experiencing the benefits of digitized records in Texas Health Resources hospitals, because the records are accessible to the appropriate care-giving team regardless of where the patient is moved in the hospital, Velasco said.

“From the ER to radiology to a patient floor, the patient’s chart is available electronically with no chance of the paper trail getting lost,” Velasco said.

Texas Health has installed a computerized provider order entry, or CPOE system, to help physicians make decisions based on evidenced-based practices, Marx said. The system streamlines the ordering of clinical tests and medications, gives allergy and drug interaction alerts, and eliminates the possibility of errors caused by doctors’ sloppy handwriting.

The federal government’s standards for “meaningful use” of electronic medical records require at least 10 percent of physicians to enter their orders directly into CPOE systems by 2011 for hospitals to earn Medicare and Medicaid bonus payments, and the usage requirements ratchet up in future years. Texas Health Resources’ hospitals have an average CPOE usage rate of 80 percent, and some of the systems’ hospitals are over 90 percent, Marx said.

“We’re among the top in the country, which is incredible,” he said. “It’s a very enviable statistic.”

Baylor efforts

The Baylor Health Care System will also spend more than $200 million by 2012 to put the first generation of its electronic health records system in place, said Dr. Joseph Schneider, chief medical information officer for the system. Those systems will need to be updated and eventually replaced as technology evolves, he said.

Baylor hopes to receive more than $45 million in federal stimulus funds to offset the cost.

Five hospitals in Dallas-based Baylor’s 26-hospital network are covered by electronic health records, and installation of the system is under way at two more, Schneider said. All of them will be covered by the end of 2012, he said. About half of the system’s 131 HealthTexas physician clinics are up-to-speed as well, he said. The rollout of electronic health records is taking place one hospital at a time.

“We’re trying to achieve truly meaningful use,” Schneider said. “We’re not just trying to achieve the requirements of the government. We’re trying to go beyond that to meet our own internal requirements.”

The system’s biggest challenge in implementing electronic health records is connecting Baylor’s network to external organizations, such as public health departments and the state’s immunization registry, Schneider said.

Parkland’s plan

Parkland Health & Hospital System has spent about $70 million bringing its electronic medical records system into compliance with the new requirements, said Jack Kowitt, senior vice president and chief information officer for the system.

The hospital system completed installation at Parkland Hospital in June 2009 after 18 months of work, and completed the system’s 10 community clinics in October 2009, Kowitt said. Installation work is under way at the system’s 120 outpatient clinics and should wrap up within a month, he said.

The biggest challenge was training the nearly 3,000 nurses and 2,000 other health care providers how to use the system, Kowitt said. Nurses received 12 hours of training and doctors received four to eight hours, depending on whether they had used the system before, he said.

“Our researchers won’t have to go through charts, case by case,” he said. “They can say, ‘Let me see all the cases with asthma,’ and see what’s the best treatment for asthma.”

Methodist’s method

Methodist Health System in Dallas is in a “pretty good position” to meet the meaningful use requirements for the first stage of the federal incentive program, said Pamela McNutt, senior vice president and chief information officer for the system. The first stage ends Sept. 30, 2012. Higher standards will then be phased in. Stage 1 standards for meaningful use were finalized in mid-July, and hospital officials nationwide are trying to figure out all of the implications, McNutt said.

The Methodist system has been building its electronic health records system since 2004, she said. McNutt declined to say how much the hospital system expects to spend to build its network because the requirements and the way the systems are implemented are moving targets, she said. It’s too soon to say how much the hospital may receive in federal stimulus reimbursement, she added.

“An electronic health record is not a thing that goes in and then it’s done,” McNutt said. “It is a very long journey to automate every scrap of information that a hospital has.”

The federal requirements have changed electronic medical records from a nicety to a necessity, McNutt said.

“It’s changing the culture and mentality of health care organizations and making us realize that we really have to get going on this,” she said. “It has created a real mindset that we have to do more automation and do it faster than we were doing it.”

The downside is that everyone is trying to do everything at the same time, McNutt said. That has started to create a shortage of people trained and capable of installing electronic health systems, she said.

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